1. Palliative Care and M/XDR-TB Global burden of M/XDR-TB
18-19 November, 2010
Geneve, Switzerland
Global burden of M/XDR-TB
Ernesto Jaramillo
WHO/Stop TB Department

2. Estimated number of cases Estimated number of deaths
The global burden of TB in 2008
Estimated number of cases
Estimated number of deaths
All forms of TB
1.3 million*
9.37 million
HIV-associated TB
0.52 million
This slide that contains all essential numbers
WHO estimates that worldwide in 2007 over 9 million TB cases occurred (and of those, 4 million infectious, sputum-smear (+)).
1.65 million people died of TB, which means 4500 every day.
WHO estimates, based on surveys conducted in over 110 settings in the last decade, that nearly half a million cases are multi-drug resistant, and 130,000 of them lethal
WHO estimates that XDR-TB cases, which are resistant to all most potent first-line and second-line, reserve drugs, were about 50,000, the majority of which are lethal.
Finally, well over 700,000 cases of the 9 million are linked with HIV/AIDS. This is slightly less than 10%. In Africa, this % is much higher, up to50%. In the rest of the world, however, the vast majority of TB cases are not due to HIV.
1.4 million (15%)
Multidrug-resistant
TB (MDR-TB)
440,000
>150,000
*excluding deaths among HIV+ people

3. TB incidence rates falling globally after peak in 2004
1990
1995
2000
2005
Peak in 2004
150
Rate per 100,000 population
145
140
135
130
World as a whole on track to achieve MDG target 6.c
125
120

5. M/XDR-TB 2010 global report on surveillance and response
440,000 MDR-TB cases
estimated to have emerged in 2008
(3.6%of all incident TB cases globally)
150,000 MDR-TB cases
estimated to have died in 2008
This report presents drug resistance data from 114 countries and updated information from 35 of them. Despite the growing understanding of the magnitude and trends in drug-resistant TB, major gaps remain in geographical areas covered. Since 1994, only 59% of all countries globally have been able to collect high quality representative data on drug resistance. There is an urgent need to obtain information, particularly from Africa and those high MDR-TB burden countries where data have never been reported: Bangladesh, Belarus, Kyrgyzstan, Pakistan and Nigeria. Moreover, countries need to expand the scope of their surveys to cover entire populations, repeat surveys are needed to better understand trends in drug resistance and countries need to move towards adopting systematic continuous surveillance. 

6. Countries with at least one confirmed XDR-TB case, as of July 2010
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
 WHO All rights reserved

7. 28 settings with > 5% MDR-TB among new TB cases, 2001-2009
Indicates data presented in the M/XDR-TB 2010 global report on surveillance and response
Indicates data reported in an
earlier phase of the project

8. Treatment success: TB, MDR-TB, XDR-TB
Source of data:
- TB: best performing NTP from HBCs
- MDR-TB: average from GLC-approved sites
- XDR-TB: well performing MDR-TB treatment programme in absence of HIV

9. What is life for a person affected by M/XDR-TB?
Poorest of the poor
Diagnosis
Treatment
tolerance
adherence
Response to treatment
Co-morbidities
Lung deterioration
Breathlessness,
respiratory failure
(may include pain)

10. People affected by TB are not sick bodies!
Depressed, fearful of dying, future uncertain
Lonely, unheard/misunderstood
Coping alone with grief
(denial, guilt, anger, fear)
Unsure about what decision to make concerning treatment
Worried about leaving children behind

11. How many other TB patients are suffering from similar conditions?
The proportion of people with TB with this suffering increases as successful cure rates decreases
Death Rates
Success Rates
67%
86%
60%
<50% 4% 7%
37 551
New: 8%
Ret: 13%
23%
11 (out of 48)
Numbers
New
cases
Retreatment
cases
MDR-TB
XDR-TB
END OF
LFE
Source: - Global TB Control short update, web tables
- M/XDR: 2010 global report on surveillance and response
- Mitnick et al. Comprehensive treatment of XDR-TB (New England journal of medicine)

12. MDR-TB epidemic 440,000 estimated cases in 2008
No treatment reported. Some treatment probably obtained, quality unknown
440,000 estimated cases in 2008
Countries report treatment, standard unknown (7%, including GLC programmes) 7% 3%
Treated in GLC approved programmes 12

13. Countries with GLC-approved projects vs
Countries with GLC-approved projects vs. countries with approved project expansion

14. We have political commitment from national governments

17. The number of patients to be treated for MDR-TB should reach around
in 2015.
The total number of people to be treated in the five years 2011–2015 is approximately
1 million

24. Countries, WHO and the Stop TB Partnership have strong partners, but…

25. HOW CAN YOU HELP?